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Dr. George McKee, Dentist

Category: Dental

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Experience: Licensed dentist with 30 years clinical experience in general practice and cosmetic reconstruction.

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I have a cavity in one of my wisdom teeth, and my dentist ...

Resolved Question:

I have a cavity in one of my wisdom teeth, and my dentist says it will be hard to fill. He has been after me to have my wisdom teeth removed, as there is some bone loss that he feels will continue and accelerate the bone loss to the teeth forward. I have a history of perodontal (sp) desease. The teeth are in fine, and the wisdom tooth dentist says I have plenty of room for them. I am 55 years old. Should I get a second opinion, or just get it over with?

If you were 20 years old I might be inclined to tell you to have the wisdom tooth out. However at age 55 I must congratulate you on only having a little bone loss around the wisdom teeth. There is no reason you can't maintain the periodontal health of these teeth for many more years, especially if you get you teeth cleaned a few times a year to keep the bone loss at bay. Because you have plenty of room for this tooth and can keep it clean, I would have it filled. Yes, it's a little more difficult for us to fill a wisdom tooth as it's so far back, but that's out job. It's much easier to remove a wisdom tooth than fill it. Unless the periodontal status of this tooth deteriorated significantly, I don't see a reason to take it out.

I hope this answers your question. If you would like to discuss this further or have any additional questions, please reply to my answer and I will get right back to you.

Reply to Dr. George McKee's Post: I guess the question is "how much bone loss". My dentist seems to think this will develop into a problem in the future and is inevitable. I have insurance now (that I might not have in the future) so is there a downside to taking them out. I'd rather not.

Customer:replied 6 years ago.

Just to be clear. all four wisdom teeth are to be removed, not just the one with the cavity. I'm checking with my dentist to see how "Significant" the bone loss is.

Customer:replied 6 years ago.

I guess the question is "how much bone loss". My dentist seems to think this will develop into a problem in the future and is inevitable. I have insurance now (that I might not have in the future) so is there a downside to taking them out. I'd rather not.

Periodontal bone loss is measured by probing and measuring the periodontal pocket, that is, distance between the top of the gum and the supporting bone under neath. The more bone loss the deeper the pocket that can trap food and bacteria, far away from your ability to keep the area clean. Healthy pocketing is 3 to 4 millimeters. 5 to 6 is marginal and deeper than 6 is cause for concern.

You do have a financial reason to have them out now with the insurance coverage. The only downside to having them removed are the possible complications of removing any tooth. Unless the roots are severely curved, the extractions should be relatively easy as your teeth are completely erupted, therefore no incisions or bone removal would be needed as is the case with impacted wisdom teeth. Once the teeth are out and the areas healed, there are no downsides to having had them out.

You are asking the age old question we are faced with in dentistry every week. To keep or remove wisdom teeth. You have an advantage in that yours are fully erupted and functioning. The only reason you would have to have them out is if the bone loss is bad enough to affect the neighboring teeth and cause periodontal abscesses. I think you need to find out the periodontal pocket measurements on these teeth to make a completely informed decision. By the way, the more bone loss there is around a tooth, the easier it is to remove it, however, the older you are, the more brittle the bone and the harder it is to remove the teeth.

If I were in your position and the pocketing was 5 millimeters or less, even 6 millimeters if I was having regular cleanings, I would keep the teeth as the age factor and relatively good bone level would make the extractions more difficult. If the pockets are 7 millimeters and higher, the periodontal disease has a good chance of affecting the bone of the adjacent teeth and the extractions would be easier due to the bone loss. I would have them out in this case.

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